Summer 2023

Adding routine vaccinations to your child’s back-to-school checklist is a great way to ensure this school year kicks off on the right foot. Adhering to your child’s vaccination schedule and routine checkups plays a critical role in preventing the spread of infectious diseases, especially as students reunite in the classroom. According to the Centers for Disease Control and Prevention (CDC), children that do not follow immunization guidelines are more susceptible to diseases such as measles and whopping cough. 

There are a number of resources available to parents to help ensure that you are on track with your child’s health services. The CDC provides this easy-to-follow chart outlining immunizations that are recommended for school-aged children, 7-18 years old. By making your child’s recommended vaccinations a priority in back-to-school preparations, you are providing protection both for them and for those around them. 

In addition, well-checks and preventative services contribute to the overall fight against serious illness.  In 2022, the Office of Disease Prevention and Health Promotion (ODPHP) launched MyHealthfinder, an online tool that offers reliable information about vaccinations and preventative care specific to your age and gender, as well as helpful information on a variety of health topics. Through MyHealthfinder, you are empowered to take proactive control of you and your child’s health, in turn contributing to the overall health of your community.

By utilizing the Myhealthfinder tool and consulting your child’s pediatrician, you can ensure that you’re on schedule with their routine vaccinations and preventative services to minimize the spread of infectious diseases and enjoy a safe, healthy school year.

Since the beginning of 2023, you may have observed lawmakers casting a spotlight on the Pharmacy Benefit Manager (PBM) industry. PBM reform has gathered broad support from both sides of the aisle and Congress is currently considering several acts at various stages of the legislative process. Through these acts, lawmakers intend to drive solutions that would decrease prescription drug costs for health plans and patients. As the buzz around PBM reform grows, here’s what you need to know:

• Lawmakers are calling for improved options and access to critical medications by utilizing generic products or biosimilars. Generics and biosimilars provide pathways to more high value, low cost treatment as compared to branded products.
• Many of the proposed acts are focused on increased transparency in PBM reporting. Plans and patients stand to benefit from increased transparency in that the total cost of their prescription drug spend would be even more apparent and understandable.

PBMs play a critically important role in containing drug costs and deliver significant value to health plans and patients. As such, PBD’s driving principle is, and always has been, excellence in service and quality care that protects your bottom line. Our values are already aligned with much of what’s being proposed, and we are well positioned to seamlessly integrate and adhere to any new guidelines as they come up.

PBD surveys members annually to gain a better understanding of their overall satisfaction with our service. As your PBM, we strive to deliver straightforward, convenient benefits that provide high value, quality care to you and your family.

Through a randomized sampling, some members will receive our Annual Satisfaction Survey in the coming weeks. We ask that members kindly fill out the survey with detailed feedback to help us better serve you moving forward.

The insight gathered through member responses helps in the planning and development of PBD’s service strategies for the coming year. PBD is committed to excellence in service and quality care, and your valuable feedback will help us explore opportunities for improvement and focus on what matters most to you.

Independent Health Pharmacy and Therapeutics (P&T) Committee, made up of 14 participating physicians and 4 network community pharmacists, meets quarterly to review and make changes to the drug formulary. All drug tier decisions made by the committee are based on efficacy and safety first, and economic value only after clinical effectiveness has been determined.

Here are changes to the Pharmacy Benefit Dimensions drug formulary that were recommended by the P&T Committee at its August 2023 meeting:

The following medications were added to the formulary:

The following changes were/will be made to the formulary:

• Albendazole tablet – remove PA 
• Amoxicillin/clavulanate ER 1000-62.5mg tablet – move from tier 1 to tier 3
• Azathioprine 75mg and 100mg tablet – move from tier 2 to non-formulary
• Azelex 20% cream – move from tier 2 to tier 3
• Cefixime 400mg capsule & oral suspension – move from tier 1 to tier 3
• Cephalexin 750mg capsule – move from tier 1 to tier 3
• Cleocin 100mg suppository – move from tier 2 to non-formulary
• Cyclobenzaprine 7.5mg tablets – from tier 1 to non-formulary 
• Erythromycin ethylsuccinate 400mg tablet – move from tier 1 to tier 3
• Leflunomide tablet – remove PA
• Pretomanid tablet – remove PA
• Rifabutin tablet – remove PA

The following new generic medications are available:

The following medications were reviewed and will remain non-formulary:

• Zolpidem 7.5mg capsules

The following medications were reviewed and will be covered as a medical benefit:

• Abrysvo®
• Beyfortus®
• Brixadi®
• Columvi® - PA, SP
• Elfabrio® - PA, SP
• Epkinly® - PA, SP
• Elrexfio® - PA, SP
• Izervay® - PA, SP
• Lantidra® - PA, SP
• Roctavian® - PA, SP
• Rystiggo® - PA, SP
• Talvey® - PA, SP
• Vivimusta® - PA, SP
• Vyjuvek® - PA, SP
• Vyvgart Hytrulo® - PA, SP
• Xacduro® - PA
• Ycanth® - PA, SP

Please reach out with any questions you may have. To best assist you, choose from the following:

Questions about your pharmacy benefits as a PBD member? Contact Member Services, 1-888-878-9172.

Questions about a claim from a pharmacy or provider? Contact our Pharmacy Help Desk, (716) 635-3578.

Questions about the benefits of partnering with PBD? Contact our Sales Department, (716) 860-0743.

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